| NPI | 1316120827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB09276300) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MB09276300) |
| 2086S0127X Surgery, Trauma Surgery (Licence: GA 66049) | |
| 208600000X Surgery (Licence: PA OT011718) | |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2024-04-10 |